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To review the treatment efficacy and to assess the complications encountered in patients with single renal or ureteral calculi managed with a new-generation SWL machine, the Siemens Lithostar Modularis Uro-Plus.The stone location, size, minimum and maximum energy used, localization technique, number of shockwaves, fluoroscopy time, and number of sessions were reviewed for 2670 patients. The medical records were consulted to identify post-SWL secondary treatments in order to calculate the efficacy quotient (EQ).The stone-free rate was 79%. Calculi in the renal pelvis and upper, middle, and lower ureter had success rates of 86%, 86%, 86%, and 85%, respectively (P0.05). Higher re-treatment rates were encountered for midureteral stones (P0.05). The major complications were renal hematoma, acute pyelonephritis, perirenal abscess, and acute pancreatitis. The overall EQ was 0.67. The EQ was higher for the renal pelvis (0.73) and upper ureter (0.71).Our experience has shown that this new lithotripter is safe and provides a 68% to 86% chance of stone clearance.

Introduction: To demonstrate the relationship between testicular microlithiasis and testicular tumor development. Patients and Methods: Between January 1996 and March 2004, bilateral testicular microlithiasis was found in 40 of the 5,263 patients who underwent scrotal ultrasonography yielding a prevalence of 0.76%. Of the 40 patients, 4 patients with concomitant testicular tumors were excluded from the study. The remaining 36 patients were enrolled into the study and followed by ultrasonography at 6-month intervals. Results: Patient ages ranged between 1 and 69 years (mean 31 ± 14 years). The median ultrasonography follow-up was 34 months (range, 1–96). Testicular tumor development was not observed in any of these 36 patients during the follow-up period. Conclusions: Extensive evaluation including computerized tomography, testicular tumor markers and testicular biopsyof patients with testicular microlithiasis is unnecessary and also increases patient anxiety. Yet annual ultrasonography and physical examination should be performed if ever until testicular microlithiasis is completely accepted as a nonpremalignant disease.

Objective: This study sought to investigate whether ischemia-induced prostate damage during cardiac surgery involving cardiopulmonary bypass causes bladder outlet obstruction. Materials and Methods: The study involved 37 men who underwent elective cardiac surgery involving cardiopulmonary bypass. Prostate-specific antigen (PSA) levels were determined preoperatively (baseline) and on postoperative days 1, 5, and 30. In 4 cases, the PSA level after the operation was unchanged from the preoperative level, so these 4 men were excluded from the study. In the remaining 33 patients, symptoms of bladder outlet obstruction were assessed using the International Prostate Symptom Score. Each subject completed this test preoperatively and 3, 6 and 9 months postoperatively, and the means scores at these time points were compared. The effects of patient age, operative time, CPB time, and aortic clamping time on postoperative increases in PSA levels were investigated. Results: Thirty-three (89.2%) of the 37 men exhibited increased postoperative PSA levels compared to baseline. The mean PSA level for the 33 cases on day 5 was significantly higher than the baseline mean, but the mean levels on postoperative days 1 and 30 were comparable to baseline. Nine (24.3%) of the 33 men had postoperative PSA levels greater than 4.0 ng/dl (the upper normal limit). There was no significant difference between preoperative and postoperative International Prostate Symptom Scores. Conclusion: The study indicates that men’s PSA levels are, indeed, increased after cardiac surgery with cardiopulmonary bypass. However, in 9 months of follow-up, there was no association between this PSA rise and development of BOO, according to International Prostate Symptom Scores.

In this study we investigated hypoxia inducible factor-1alpha (HIF-1alpha) and vascular endothelial growth factor (VEGF) expression, and angiogenesis in an experimental model of varicocele in the rat testis.A total of 30 adult male Sprague-Dawley rats were investigated in 3 groups, namely varicocele group 1 (13), sham operated group 2 (9) and control group 3 (8). At 30 days after surgery was completed in groups 1 and 2 orchiectomy was performed in all rats. Histological findings in the left testicles of rats from each group were compared. HIF-1alpha and VEGF expression was immunohistochemically studied and CD31 panendothelial antigen was used to identify the number of microvessels, that is microvessel density (MVD), in paraffin embedded sections of testis tissue. Data were analyzed using the chi-square test, Fisher's exact test, 1-way ANOVA and the Tukey HSD test for post hoc comparison.HIF-1alpha expression was detected in 12 specimens (92.3%) in group 1, 4 (44.4%) in group 2 and 2 (25%) in group 3. The frequency of HIF-1alpha positivity in group 1 was significantly higher than the rates in groups 2 (p = 0.023) and 3 (p = 0.003). VEGF expression was detected in 8 specimens (61.5%) in group 1 but none of the group 2 or 3 specimens were VEGF positive. The frequency of VEGF positivity in group 1 was significantly higher than that in groups 2 (p = 0.006) and 3 (p = 0.007). Mean MVD +/- SD in group 1 was 7.53 +/- 1.50 (range 6 to 12), and findings in groups 2 and 3 were 5.88+/-1.45 (range 4 to 8) and 5.12 +/-1.12 (range 4 to 7), respectively. Mean MVD in group 2 was higher than in group 3 but this difference was not significant (p = 0.509). Mean MVD in group 1 was significantly higher than the mean values in groups 2 (p = 0.030) and 3 (p = 0.002).Previous study of experimental varicocele models in rats documented HIF-1alpha and VEGF expression combined with angiogenesis in the testis. The results of this study show that varicocele can lead to tissue hypoxia and related pathophysiological events, such as angiogenesis.

Introduction: We aimed at evaluating the outcomes of transurethral prostatectomy and inguinal hernia repair performed in a single session. Patients and Methods: Fifty-six patients (mean age 68 ± 8.3 years) in whom transurethral prostatectomy was performed combined with an inguinal hernia repair were included into the study. Type of anesthesia, technique of inguinal hernia repair, hospitalization time, and the complications encountered were recorded. Cost comparisons were made using the official price-lists of the Turkish Medical Assocation. All patients were asked whether they were satisfied with the outcome of both operations performed in one session. The data obtained from the patients who underwent both operations in one session were compared with those obtained from 56 patients who underwent transurethral prostatectomy only (control group). Statistical analysis was performed using the chi-square test corrected for continuity according to the Yates or the Fisher exact test. Results: The operations were performed in 19 patients under general, in 20 patients under epidural, and in 14 patients under spinal anesthesia. Three patients were given general anesthesia and spinal anesthesia combined. In 6 patients bilateral and in 50 patients unilateral hernia repair was performed. In 11 repairs, polyprolene mesh grafts were utilized; in 2 repairs, a laparoscopic method was used, and in the remaining 49 repairs, one of the conventional techniques (McVay, Bassini, or Shouldice) was employed. There were no significant differences with regard to early and late postoperative complications and satisfaction between study group and control group (p > 0.05). Combined prostatectomy and hernia repair allows approximately 30% cost profit. Conclusions: Performing transurethral prostatectomy and inguinal hernia repair in one session decreased the number of the operations and anesthesias, hospital stay, and thus health costs and did not cause an increase in operative and postoperative morbidity.

Although secondary renal involvement from systemic lymphoma is very frequent, primary renal lymphoma is a rare entity. It is characterized by aggressive histopathology, very early extra-renal infiltration and poor prognosis.Here, we report 4 cases of primary renal lymphoma presenting with unilateral renal masses, which after radiological and clinical examination were assumed to be renal cell carcinoma. 3 patients were diagnosed with Non-Hodgkin's lymphoma by nephrectomy and one patient was diagnosed by open renal biopsy. Histopathological subtypes were diffuse large B cell lymphoma in 2 cases and non-Hodgkin's lymphoma of small B cell type in the others. While 3 of the patients were treated with systemic chemotherapy, the fourth patient refused chemotherapy. 2 patients (no. 2 and 3) were still in complete remission and were followed regularly in the second and first year after diagnosis, respectively.Since it is difficult to diagnose primary renal lymphoma, most patients with this kind of tumor undergo radical nephrectomy, and diagnosis of primary renal lymphoma is delayed. The authors believe that both the delayed diagnosis due to anatomical difficulties and the histological aggressive characteristics of this disease are equally responsible for the poor outcome in the case of primary renal lymphoma.

Introduction: This study was undertaken to investigate the effects of two different α1-adrenergic blockers on bladder hypertrophy using ultrasound-estimated bladder weight (UEBW) and to assess the relation between changes in UEBW and other objective and subjective parameters of disease severity in patients with benign prostatic hyperplasia (BPH). Materials and Methods: 41 men were enrolled in the study and they were subjected to either watchful waiting (group 1) or α1-adrenergic receptor blocker therapy (group 2 with alfuzosin; group 3 with tamsulosin). The patients were investigated by symptom evaluation using the International Prostate Symptom Score (IPSS) and quality of life score (QOL), uroflowmetry and UEBW. The parameters were assessed again 3 months after initiation of treatment and compared with the initial values. Results: While the mean UEBW increased in group 1 (42.2 ± 10.3 to 52.5 ± 12.2 g), it decreased in both the other groups that received α-blocker therapy (61.3 ± 18.7 to 41.1 ± 13.2 and 59.4 ± 17.2 to 43.5 ± 17.6 g, respectively). In groups 2 and 3, the mean UEBW, post-void residual urine, IPSS and QOL values decreased, and the mean maximum flow rate increased. All of the changes in group 2 and all except QOL in group 3 were statistically significant (p < 0.05). The changes correlated well with each other with regard to treatment success. The highest decreases in UEBW were encountered in patients with heavier bladders. Conclusions: UEBW decreases with α1-adrenergic receptor blockers. When used together with the other objective and subjective parameters, UEBW is a promising quantitative parameter as a follow-up tool and can be useful in monitoring the therapeutic effects of α1-adrenergic receptor blockers.

Adenosquamous carcinoma of the prostate is an unusual histological variant of prostate cancer. The histogenesis of this tumor remains uncertain. The stimulus for the development of the squamous metaplastic cells had been thought to be related to hormone and/or radiation therapy. This report presents a case of adenosquamous carcinoma of the prostate with abscence of previous hormone or radiation therapy. The case showed negative prostate-specific antigen and high molecular weight cytokeratin staining of the adenocarcinoma component, and negative prostate-specific antigen and positive high molecular weight cytokeratin staining of the squamous cell carcinoma component. The adenocarcinoma component stained intraluminally with periodic acid schiff. The staining features and the distinct localizations of the components with intermingling, but no transition, are against the collision-type tumor theory and support the theory that the adenocarcinoma and squamous components arise de novo from pluripotent stem cells. The patient had a rapid downhill clinical course and died 3 weeks after the diagnosis was made.

We investigated the presence of p53 expression and apoptosis in an experimental model of varicocele in the rat.A total of 30 adult male Sprague-Dawley rats were studied in 3 groups, namely group 1-13 with varicocele, group 2-9 with sham operation and group 3-8 controls. All animals underwent orchiectomy after 30 days and sections of the left testis from each animal were studied. TUNEL was used to detect apoptotic germ cells and an apoptotic index (AI) was calculated for each testis specimen. p53 expression was determined immunohistochemically and graded according to the proportion of cells stained in each specimen.AI values in group 1 testes were 0% to 0.51% (mean 0.06% +/- 0.13%) and the corresponding range in group 2 was 0.04% to 0.69% (mean 0.25 +/- 0.21%). No group 3 control specimens showed TUNEL staining (AI 0% in all). Although the mean AI in group 1 was higher than that in controls, this difference was not statistically significant (p = 0.318). The mean AI value in group 2 was significantly higher than in the control group (p = 0.021) but it was comparable to that in group 1 (p = 0.099). Seven (53.8%) and 2 (22.2%) specimens in groups 1 and 2, respectively, showed p53 staining in germ cell nuclei. None of the specimens in group 3 showed nuclear p53 expression. The grade of p53 expression in group 1 was significantly higher than that in groups 2 (p = 0.042) and 3 (p = 0.011). Expression grades in groups 2 and 3 were not significantly different (p = 0.426).To our knowledge p53 expression that may reflect abnormal spermatogenesis has been documented for the first time in an experimental model of varicocele in the rat testis. In contrast to other investigations, no link between apoptosis and varicocele was detected.

The rare clinical occurrence of the spontaneous passage of bullet which was not found during an operation after a gunshot wound to the bladder in a 28-year-old man is described.

Objectives To compare the success and complication rates in the treatment of ureteral stones with a 7.5F versus a 10F ureteroscope. Methods A total of 100 patients who were scheduled for ureteroscopy to treat ureteral calculi between December 2000 and December 2002 were randomly assigned to procedures with a 7.5F (group 1; n=50) or 10F (group 2; n=50) ureteroscope. The group results were compared. Results Group 1 had 36 distal, 9 middle, and 5 proximal ureteral stones. Group 2 had 37 distal, 6 middle, and 7 proximal ureteral stones. No statistically significant differences were noted between the two groups with respect to the mean stone size or operation time ( P = 0.175 and P = 0.636, respectively). Pneumatic lithotripsy was used in 62% and 50% of the procedures in group 1 and 2, respectively, and stones or fragments were retrieved with basket catheters in 92% and 76% of the group procedures, respectively. The difference between the group rates for successful basket catheter extraction was statistically significant ( P = 0.029). Of the patients in group 1 and 2, 84% and 80%, respectively, were stone free after a single procedure ( P = 0.603). The corresponding failure rates in the two groups were 6% and 12% ( P = 0.295), and the corresponding early and late complication rates in the two groups were 6% and 4% ( P = 0.646). None of the patients in group 1 developed late complications. One individual (2%) in group 2 developed ureteral stenosis during long-term follow-up ( P = 0.315). Conclusions The success and failure rates revealed better outcomes for treatment of ureteral calculi with a 7.5F ureteroscope, but the differences were not statistically significant. The complication rates were similar between the two groups. Basket catheters were used more frequently with the 7.5F scope, and the rates of in situ lithotripsy and postoperative ureteral stent placement were also greater in patients treated with this instrument.

Objective: The aim of this study was to evaluate the effect of long-term sitting on serum prostate-specific antigen (PSA) levels. Method: The serum PSA levels of 50 bus drivers under the age of 45 (mean 37.7) years who worked at least 8 h a day for more than 3 weeks were compared with those of 50 healthy surgeons in similar age groups (mean 37.7 years) who spent most of their working time standing. Results: There was no statistically significant difference between the mean PSA level of the study group (1.211 ± 0.96 ng/ml) and that of the control group (1.214 ± 0.74 ng/ml; p > 0.05). The PSA levels returned to normal after a 5-day resting period in cases who had higher values than the anticipated 2.5 ng/ml for this age group at the initial determination. Conclusions: These results suggest that there is no relationship between long-term sitting and serum PSA levels. A second PSA determination after a 5-day resting period may be helpful in cases with higher than normal initial values.